Effectiveness of thoracic interventions on psychological factors in low back pain: a systematic review and meta-analysis.

Abstract

Fear of movement and anxiety are major psychological contributors to disability in individuals with low back pain (LBP). Thoracic-focused rehabilitation, including breathing and chest mobility exercises, has been proposed to improve both physical and psychological outcomes. This systematic review and meta-analysis evaluated the effectiveness of these interventions on psychological outcomes in LBP. Seven databases (PubMed, Scopus, Web of Science, ProQuest, Ovid, PEDro, Google Scholar) were searched without language restrictions. Randomized controlled trials assessing thoracic mobility or breathing interventions in adults with LBP were eligible. Primary outcomes were fear of movement and depression/anxiety. The study followed PRISMA guidelines and was registered in PROSPERO (CRD42024558753). Eleven RCTs met inclusion. Pooled analysis showed thoracic interventions reduced fear of movement compared with controls (<i>N</i> = 441; SMD = -1.45; 95% CI: -2.45 to -0.45; 95% PI: -4.43 to 1.52), though heterogeneity was high (I² = 93.4%). No significant effects were observed for depression/anxiety (<i>N</i> = 173; SMD = -1.10; 95% CI: -2.28 to 0.09; 95% PI: -3.34 to 1.15; I² = 90.4%). Thoracic interventions may reduce fear of movement in LBP, but evidence for effects on depression and anxiety is inconclusive. Further high-quality, standardized trials are needed to clarify clinical value.